What causes indifferent mood? 14 possible conditions
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Apathy is a lack of interest in life activities and/or interacting with others. It can affect a person’s ability to keep a job, maintain personal relationships, and enjoy life.
All people experience apathy from time to time. A person may occasionally feel unmotivated or uninterested in his or her daily tasks. This type of situational apathy is normal. Apathy becomes more dangerous when someone is unmotivated to treat a chronic condition such as diabetes or mental illness.
Apathy is a symptom of a number of neurological disorders, including Alzheimer’s disease. Apathy also can be a syndrome in and of itself.
Apathy is a symptom of a number of psychiatric and neurological disorders. Examples include:
- Alzheimer’s disease
- dysthymia or chronic mild depression
- frontotemporal dementia
- Huntington’s disease
- Parkinson’s disease
- progressive supranuclear palsy
- vascular dementia
A person can also experience apathy even without an underlying medical condition.
Doctors have found lesions in the frontal lobe of the brain in patients with apathy symptoms (Ishizaki, J., et al., 2011). This leads researchers to believe that the brain’s apathy center is located in the front of the brain. If a person has a stroke that affects this part of the brain, apathy may result.
Teenagers are likely to experience periods of apathy. This typically passes with time. Long-term emotional detachment and apathy is not normal in teens.
Apathy sufferers have a lack of passion or motivation.
Apathy affects a person’s behavior and his or her ability to complete daily activities. The main symptom is a lack of motivation to do, complete, or accomplish anything. People with apathy typically have low energy levels.
Emotions, motivation, and willingness to act are often lower or diminished. Activities or events that normally interest a person will create little to no response.
Apathetic people express disinterest in many aspects of life. They are usually indifferent when they meet new people or try new things. They show no interest in activities or in addressing personal problems or concerns. Facial expressions do not seem to change. They exhibit a lack of effort, planning, and emotional response. They tend to spend more time in solitary activities.
Continued apathy affects a person’s ability to maintain personal relationships and perform well at work.
Apathy is not the same as depression, though they share some similar symptoms, such as disinterest. People with depression may also have feelings of hopelessness and guilt. Suicide may be a risk in patients suffering from depression. Apathy sufferers do not have these symptoms.
Healthcare practitioners use four criteria to diagnose apathy. People with apathy meet all four.
- A decrease in or lack of motivation: A patient displays diminished motivation that is not consistent with his or her age, culture, or health status.
- Behavior, thinking, or emotional changes: Changes in behavior may make it difficult for patients to engage in conversations or perform daily tasks. Changes in thinking include a disinterest in the news, in tasks that require deeper thinking, or in social events.
- Affect on quality of life: The changes in behavior negatively affect a person’s professional life, personal relationships, or other facets of life.
- The changes in behavior are not caused by other conditions: The changes in behavior are unrelated to physical disabilities, substance abuse, or an affected level of consciousness.
Patients must have these symptoms for four weeks or longer.
Apathy treatments depend upon the underlying cause. Medications and psychotherapy can restore interest in life. However, patients with progressive disorders such as Parkinson’s or Alzheimer’s may show chronic apathy symptoms.
Doctors prescribe medications for apathy according to the underlying condition.
- antidementia agents, which treat Alzheimer’s disease, such as donepezil (Aricept), galantamine (Razadyne), and rivastigine (Exelon)
- antidepressants, such as paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin, Zyban); a group of antidepressants called SSRIs can make apathy symptoms worse in the elderly
- cerebral circulation and metabolism stimulants that treat symptoms of stroke, such as nicergoline (Sermion)
- dopamine stimulants, which treat Parkinson’s disease, such as ropinirole (Requip)
- antipsychotic agents, which are used to treat schizophrenia
- psychostimulants, which are often used to treat apathy with no known underlying cause; examples include methylphenidate (Ritalin), pemoline (Cylert), and amphetamine
Apathy sufferers benefit from a supportive network of family and/or friends. These support networks can help them regain interest in their surroundings.
Mental health professionals can discuss concerns with patients. They can also help patients re-establish a more positive outlook on life. A combination of therapy and medication is usually more effective for apathy sufferers than each treatment alone (Ishizaki, J., et al., 2011).
Research continues on other potential treatments for chronic apathy. An example is cranial electrotherapy stimulation (Ishizaki, J., et al., 2011). This approach may help patients who suffer from apathy after a traumatic brain injury that affects the frontal lobe. A doctor applies a brief, low-voltage electric current across the forehead to stimulate the brain. The treatment is painless.
Another potential therapy is cognitive stimulation therapy. This approach is used for Alzheimer’s patients. Patients participate in group activities to stimulate brain waves. Examples include games or looking at pictures to recognize facial expressions.
Chow, T. W., Binns, M.A., Cummings, J.L.,
Lam, I., Black, S.E., Miller, B.L., et al. (2009). Apathy Symptom Profile and
Behavioral Associations in Frontotemporal Dementia vs Dementia of Alzheimer
Type. Archives of Neurology, 66(7), 888-893.
● Ishizaki, J. & Mimura. M. (April 2011). Dysthymia and apathy: diagnosis and treatment. Depression Research and Treatment. 2011, 7 pages.
● Mayo Clinic Study Finds Apathy and Depression Predict Progression from Mild Cognitive Impairment to Dementia (2010, July 12). Mayo Clinic. Retrieved September 12, 2013, from http://www.mayoclinic.org/news2010-rst/5857.html
● Moretti, R., Torre, P., Esposito, F., Barro, E., Tomietto, P., & Antonello, R. (2013). Apathy as a key symptom in behavior disorders: difference between Alzheimer’s disease and subcortical vascular dementia. Understanding Alzheimer’s Disease. Prof. Inga Zerr (Ed.). InTech. DOI: 10.5772/54264.
● Mulin, E., Llorca, P., Dessi, B., Nobili, F., Leentjens, A., Delliaux, M., et al. (2010). Diagnostic Criteria For Apathy In Clinical Practice. International Journal of Geriatric Psychiatry, 26, 158-165.
● Richard, E., Schmand, B., Eikelenboom, P., Yang, S.C., Ligthart, S.A., et al. (2012, May 11). Symptoms of apathy are associated with progression from mild cognitive impairment to Alzheimer’s disease in non-depressed subjects. Dementia Geriatric Cognitive Disorders, 33(2-3), 204-209.
● Starkstein, S.E., Petracca, G., Chemerinski, E., & Kramer. J. (2001). Syndromic validity of apathy in Alzheimer’s disease. The American Journal of Psychiatry. 158(6). 872-877.
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